Fat Transfer and Liposculpture

Liposuction/sculpture including SAFE Lipo ™

Liposuction or liposculpture are techniques that I use often in conjuction with other procedures to enhance my cosmetic results. It is important to understand that liposuction is used for contouring. Attempts at large volume liposuction in the wrong patients or wrong areas can lead to deformities that are very difficult to correct.

Liposuction uses special cannulas and suction to remove fat from the body. There are many common misconceptions about its uses. First of all, liposuction is not very difficult to perform. Therefore, some practitioners go to a weekend training seminar to learn liposuction. It is very important to go to a trained practitioner who has completed a Plastic Surgery specialty. Large volume liposuction and liposuction in the wrong areas can be not only disfiguring, but also dangerous. Half of my liposuction patients are revisions where there first procedure left him/her with major irregularities. I use liposuction/sculpture in my practice for minor contour irregularities and to enhance the result of other surgeries. This technique can be performed for contouring the neck, abdomen, flanks, lateral chest wall, hips, inner thighs, back, and knees. Your age, medical problems, ethnicity, and skin quality are all factors that will determine how your skin will react to liposuction/sculpture. The younger you are, the more likely your skin will retract to your underlying frame after liposuction. Have you ever noticed how some women have a child and their abdomen bounces right back to where they started, while others have hanging skin that they cannot get rid of know matter how much exercise they do? The same analogy works with liposuction.

Some patients can undergo just liposuction, while others will need additional procedures to reduce their overlying skin envelope to match their frame. I can’t tell you how important it is to go to a trained Plastic Surgeon to get optimal results and to minimize complications. Too
often I see patients in my practice and even in magazines that have undergone liposuction and now have major contour irregularities on their body.

  
  

Fat grafting and transfer (face/breast/buttock)

Over the last 10 years, fat grafting and transfer has increased in popularity. For the right patients, this is an invaluable tool. Fat is harvested from one area of the body using low suction cannulas and then prepared for harvest. I have tried all of the proposed techniques for fat harvesting and preparation to increase the amount of fat that survives in the recipient site. After low pressure suction, the fat is placed in a centrifuge and the fat stem cells are separated from the remaining fluid and cells. Once this is done, I prepare the fat in 0.5mL aliquots that are injected into the body. Using small amounts and spreading it out over hundreds of passes allows the newly grafted fat to develop its own blood supply in the recipient bed (face, breast, buttock, etc).

I believe that fat grafting more than any other injectable procedure requires the most precision and the most stringent criteria when selecting patients. Over-injection can cause the face to look very round and even grotesque. Also, this is NOT a good option if you are a person that has the propensity to gain a lot of weight. I have seen patients that have not only been over-injected, but also gained weight and the grafted fat increases as well. In these patients, I have actually had to remove fat, which can be very difficult.

My preferred areas to fat graft are the face, breast and buttock. Fat grafting to the face can really improve the look of the eyebrows and especially the midface—see liquid facelift. With precision, the cheek bones can really be enhanced and this looks very natural and beautiful in most people. In the lips, lower eyelids and pre-jowl areas I prefer to use injectables because they tend to settle better with less irregularities. The breast is another area that does very well with fat grafting for minor contour irregularities as well as difficult cases of capsular contracture. Especially for my breast reconstruction practice, this technique has been very helpful. Finally, fat grafting to the buttock is a natural way to increase buttock projection and to change the overall shape. Liposuction is usually done of the flanks and lower back and the fat transferred to the buttock giving my patients a very nice figure and “swoop” to their lower back and flanks.

Fat grafting, like liposuction/sculpture, is done in an outpatient setting and can even be done in the office depending on the extend of the procedure. Downtime is minimal and results are immediate. It is important to understand that the real results are seen in 3-6 months as a portion of the grafted fat does resorb.